Zentralblatt für Neurochirurgie
-
Zentralbl. Neurochir. · Jan 1998
Short-term prognostic factors in lumbar disc surgery: the low back prognostic score is of predictive value.
In order to determine prognostic factors of lumbar disc surgery, we examined 107 patients who were conventionally operated on in a prospective, consecutive study. We analysed general data, the case history, the neurological examination at admission and all data from imaging examinations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score [9, 10]. ⋯ To improve the prognostic value, we combined significant questions of the LBOS with the pain grading scale and significant prognostic factors to form a new prognostic score (Low Back Prognostic Score). With this new score we were able to predict a favorable outcome in 84% of our patients, and an unfavorable outcome in 71%. The Low Back Prognostic score seems to provide a sensitive method for predicting a favorable or unfavorable outcome for patients scheduled to undergo lumbar disc surgery.
-
Zentralbl. Neurochir. · Jan 1998
Comparative StudyNeuronavigation--first experiences with three different commercially available systems.
Growing interest in neuronavigation also referred to as frameless stereotaxy has led to the development of various navigational devices employing different localization methods. In 152 procedures the authors have used neuronavigation. Cases included 89 intracranial- and 26 skull base tumours, 9 biopsies, 21 vascular and 7 functional procedures on 144 patients since July 1993. ⋯ The mean accuracy of registration measured as RMS was 2.9 +/- 1.2 mm (VW), 3.3 +/- 0.9 mm (SPOCS) and 3.1 +/- 1.0 (MKM) respectively. Regarding intraoperative handling the VW was found to be a robust but sometimes bulky and hindering device whereas the SPOCS was more flexible but with the need of unobstructed visibility between cameras and pointers. The MKM without these restrictions required training to get used to handling.
-
Zentralbl. Neurochir. · Jan 1998
[Follow-up monitoring with magnetic resonance tomography after decompressive trephining in experimental "malignant" hemispheric infarct].
Acute ischemia in the complete territory of the carotid or the middle cerebral artery may lead to cerebral edema with raised intracranial pressure and progression to coma and death. Although clinical data suggest benefit for patients undergoing decompressive surgery for massive space occupying hemispheric stroke, little data about the effects of this procedure on morbidity and outcome is available. The experimental data support an early surgical approach. ⋯ If performed early after vessel occlusion, it also significantly reduces infarction size. In the acute phase of hemispheric infarction conventional SE-MRI is not sensitive in estimation of infarction size. Later than 24 hours, conventinal SE-MRI proved to be useful in monitoring brain edema and infarction size in this rat model of malignant hemispheric stroke.
-
Zentralbl. Neurochir. · Jan 1998
Case ReportsBedside-microdialysis for early detection of vasospasm after subarachnoid hemorrhage. Case report and review of the literature.
Continuous monitoring of cerebral metabolism would be desirable for early detection of vasospasm in SAH patients. Bedside-microdialysis, a new technique for on-line monitoring of cerebral metabolism, may reflect changes seen in cerebral vasospasm diagnosed by transcranial Doppler sonography (TCD). This report represents the first case of combined TCD monitoring and on-line microdialysis from the brain extracellular fluid in a SAH patient. ⋯ After elevation of mean arterial blood pressure, TCD values and metabolic parameters normalized. Interestingly, the pathological changes in on-line microdialysis preceded the typical increase in blood flow velocity by TCD and the clinical deterioration. Our case suggests, that bedside-microdialysis may be useful for early detection of vasospasm and continuous surveillance of treatment and may be a new guide to treat ischemic neurological deficits following SAH.